BREAST RECONSTRUCTION

BREAST RECONSTRUCTION AFTER A MASTECTOMY

Breast reconstruction restores the size and shape of breasts after mastectomy or wide local excision.  Women who have been stricken with breast cancer turn to reconstructive surgery to reclaim their body image. This can be accomplished in several ways.

Mr Mark Ho-Asjoe explains the various procedures available to you:

‘FLAP’ RECONSTRUCTION

Flap surgery is far more complex than other methods of breast reconstruction. During the procedure, Mr Ho-Asjoe partially detaches a flap of skin, muscle, and fat from the patient’s abdomen or back. He then rotates it, tunneling underneath the skin to the mastectomy site. He also makes sure that enough of the arteries and veins that channel blood through the flap, continue to do so.

He then forms the flap into a mound that matches the healthy breast as closely as possible and sutures it into position. If both breasts have been removed, a bilateral procedure using two flaps can be carried out.

Latissimus Dorsi flap

Latissimus Dorsi is the largest muscle on the back and can be used for breast reconstruction. It can be lifted from the back with a skin paddle via a transverse scar (bra strap scar) or an oblique scar. It can then replace the skin loss from the breast and part of the volume loss. In general, an implant is required for volume replacement and the muscle is mainly used for padding and skin replacement. There are pros and cons when comparing the Latissimus Dorsi flap with implant reconstruction versus purely autologous tissue (own tissue with no implant). Mr. Ho-Asjoe will explain the options available depending on your suitability at your consultation.

TRAM (Transverse Abdominus Myocutaneous) Flap

The most common type of autologous flap reconstruction is the TRAM (Transverse Rectus Abdominus Myocutaneous) flap procedure. During this procedure, a piece of skin, fat, and/or muscle is moved from the abdomen and used to rebuild a breast. In most occasions, the abdominal muscle can be spared leaving the abdominal wall structure intact. To achieve this, the single blood vessel is dissected carefully from the muscle. This is known as the Deep Inferior Epigastric Perforator flap (DIEP flap).

Both TRAM and DIEP eliminate the need for an artificial implant. Since the ‘donor’ tissue comes from the abdomen, women undergoing a TRAM/DIEP flap procedure effectively have their waistlines reduced at the same time.

OTHER OPTIONS

If the abdomen is not suitable due to scarring, lack of tissue, or other reasons, autologous tissue can be used from the buttock (S-GAP) or possibly the inner thigh (TMG flap). They are alternatives but a patient may not be suitable for the above. Consultation with Mr Ho-Asjoe will clarify the suitability and the pros and cons associated with the different options. Subsequent to the initial reconstruction, the scars surrounding the reconstructed breast heal in about two months. At this point, the surgeon may go on to create a nipple and an areola using the flap skin. Later he may tattoo the areola to give an even more natural appearance.

IMPLANTS AND ‘TISSUE EXPANSION’

A simpler and more common way to reconstruct breasts following mastectomy involves the insertion of breast implants filled with saline or silicone gel. This is often in conjunction with a procedure called tissue expansion. Tissue expansion produces improved results for many women. In particular, those who, after mastectomy, are left with chest skin that is too tight and taut to accommodate an implant of sufficient size to restore body symmetry. This procedure is now being used more widely. This is because general surgeons are performing less radical mastectomies these days and are also recommending less radiation treatment.

Women who have tissue expansion as part of breast reconstruction undergo several procedures. First, a tissue expander is placed beneath the skin, usually at the time of mastectomy. This has three parts: a saline bag, a self-sealing valve, and a tube that connects the two parts. For a period of weeks or months, your surgeon will use the self-sealing valve. These are used to fill the tissue expander with saline solution until a sufficient amount of extra tissue is created. The expander is then normally removed and a permanent saline or silicone gel implant is inserted. Although in some cases the expander can be left in place as the permanent implant.

At the same time of the exchange, some patients may benefit from an uplift, reduction, or enlargement of the opposite breast to achieve symmetry. This would have been discussed before in the initial consultation as the new breast from reconstruction is determined by the shape of the implant.

WHAT TO EXPECT AFTER BREAST RECONSTRUCTION SURGERY

The initial surgery to implant the expander causes most people only temporary discomfort, which can be controlled with medication. When tissue is expanded gradually, there may be slight discomfort each time the saline solution is injected.

Call: 0207 403 8694 or Email: enquiry@markhoasjoe.co.uk